Healthline member newsletter

Ask Your Local Member Services Representative

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan strives to provide our Members with outstanding customer service. This section of your Member newsletter focuses on answering general coverage or procedural questions that we receive on a regular basis.

Question:

What is a Primary Care Physician and how do I choose one for myself?

Answer:

One of the most important health care decisions you will ever make is selecting your primary care physician. This is your health care partner and central coordinator for everything pertaining to your good health. Primary care physicians include family physicians, internal medicine physicians and pediatricians.

The process for choosing your primary care physician is simple.

1) First, find a physician accepting new patients:

  • Access the CHP Physician Search Tool. Visit www.capitalhealth.com and on the homepage, under the phrase “Learn more about,” click on the word “Doctors”
  • On the Physician Search tool, click the “advanced search” link.
  • Use the drop down box in the category labeled “Accepting Patients” to choose “Yes”.
  • Check the box next to the words “Primary caregivers only” and then click “Go”. (If you want to narrow the search further, enter the zip code, city, medical group affiliation, and/or other search items accordingly.)
  • Review the list of primary care physicians accepting new patients and choose the one that you would like to have as your health care partner.

2) Then, notify your local Member Services Representative of your decision so our records will reflect your choice.

  • Call CHP Member Services at (850) 383-3311 - or -
  • Log on to your CHPConnect account and make your selection. This automatically sends a secure message to the Member Services staff; your selection will then be completed that evening. (You can register for a CHPConnect by visiting www.capitalhealth.com and clicking on the link titled
    in the left hand column.)

Member Services: Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services: Seven days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771

The Secret to Your Health: Your Primary Care Physician

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

One of the most important health care decisions you will ever make is selecting your primary care physician – your health care partner and central coordinator for everything pertaining to your good health. As a Capital Health Plan member, your primary care physician knows you well and provides expert health care advice tailored to your needs. Primary care physicians include family physicians, internal medicine physicians and pediatricians. You have the choice of over 125 primary care physicians across the Capital City region, including practitioners at two CHP medical centers dedicated exclusively to Capital Health Plan members.

Finding the right physician for you is now easier than ever with the Physician Search Tool on capitalhealth.com. Advanced search options allow you to search by a variety categories including specialty, affiliation, and closeness to you. For best results, start with a broad search and add specifications to narrow the results.

  • Check out this NEW feature! The status flag tells you if each physician is accepting new patients. Hover over the flag with your mouse to find out more information.

 

 

 

Primary Care is Cost Effective!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

 

A recent study by Johns Hopkins University found that traditional fee-for-service Medicare could save approximately $10 billion a year by avoiding unnecessary hospitalizations.

The study, commissioned by the Alliance of Community Health Plans (ACHP), compared the Medicare Retiree Advantage programs of community based health plans, including Capital Health Plan, against traditional Medicare.

In traditional Medicare, hospital readmissions account for $17 billion of the $102.6 billion spent in hospital payments each year. The results of the study show that Capital Health Plan outperformed traditional Medicare in hospital readmission rates, preventable ER visits, and preventable hospital admissions. With rates similar to that of CHP, traditional Medicare could save approximately $10 billion annually.

Chief Medical Officer Dr. Nancy Van Vessem explains how we are able to accomplish these low rates:

“At Capital Health Plan we believe that access to strong, consistent outpatient care by a physician who knows the patient is the best defense for avoiding unnecessary hospital admissions and emergency room visits.”

“That same relationship improves transitions of care between the inpatient and outpatient setting and contributes to CHP’s low rate of readmissions within 30 days. Our Care Coordination Department and the nurses in our staff model practice, contact at-risk members to ensure that follow-up appointments with their primary care physician are organized within a week of discharge from the hospital.”

The Johns Hopkins research further supports Capital Health Plan’s philosophy that focusing on coordinated care and preventative health maintenance will improve care and lower costs.

 

Hospital Readmission Rate Within 30 days Preventable ER Visits (per 100 member months) Preventable Hospital Visits (per 100 member months)
Capital Health Plan 7.68% 2.76 1.44
Medicare Fee-for-Service 18.6% 15.5 19.0

 

Dr. Nancy Represents CHP at NCQA Press Conference

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

 

On October 22nd the National Committee for Quality Assurance (NCQA) held a news conference in Washington, DC to release “The State of Health Care Quality: 2009.” The report is produced annually to monitor performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement. It also provides an exclusive look at how well the health system performed over the past year in key areas of care and service. Data is drawn from audited data conveyed to NCQA through its Health Care Effectiveness Data and Information Set (HEDIS®) -- the most widely used performance measurement tool in health care -- as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

Dr. Nancy Van Vessem represented Capital Health Plan at the press conference, which focused on the achievements of a few notable health plans in the country. She highlighted Capital Health Plan’s achievements in Diabetes and Coronary Heart Disease Relative Resource Use (RRU) measures. NCQA will start publicly reporting HEDIS® RRU measures in 2010. These measures, unlike previous HEDIS® measures, assess the efficiency of care delivered by health plans for certain chronic diseases. In general, CHP members require less “rescue” such as inpatient admission and emergency room visits than members in other health plans.

Dr. Van Vessem emphasized that the long-term success of CHP is rooted in its high member satisfaction, high levels of trust, and low disenrollment. This means members with diabetes and coronary heart disease have been involved with local physicians and disease management programs over many years. They have fewer gaps in care attributed to a consistent approach to chronic disease and stable benefits.

“At Capital Health Plan we encourage every member to have a primary care physician. Our goal is to help the physicians manage the chronic disease of their patients,” said Dr. Van Vessem. One of the newest enhancements is that primary care physician offices can access its patients’ information related to gaps in care for a variety of quality measures via CHPConnect. This collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores. Now, that success has continued with notable performance on relative resource use measurements.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).